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Modeling Financial Outcomes and Quantifying Risk in Episode-Based Payment Models

This article provides a description of prospective financial simulation methodology and use cases with empirical data for episode-based bundled payments, including implications for contract negotiations and value-based care redesign.

Consumer Data Transparency Is More Important Than Ever as the Battle Against COVID Rages On

On January 1, CMS implemented the Hospital Price Transparency final rule, but by July, it was clear that many hospitals were noncompliant. Even with a proposed rule for penalties, requirements still only fall on certain parts of the health care industry.

The Potential Role of Targeted Therapy for Secondary T-Cell Lymphoma After CAR T-Cell Therapy

A targeted therapy combination achieved complete remission in a CAR-positive PTCL patient post-CAR T-cell therapy for multiple myeloma.

Cost Savings Associated With Electronic Specialty Consultations

This retrospective cohort evaluation found that patients receiving electronic, compared with face-to-face, specialty consultation had significantly lower health care costs for at least 3 months.

Hospital at Home: Paying for What It’s Worth

A framework centered around cost, quality, and equity is essential to define the value of hospital-at-home programs.

Varied Use of Step Therapy Among Medicare Advantage Plans

The frequency with which 7 of the largest Medicare Advantage plans impose step therapy protocols in their Part B drug coverage decisions varies substantially.

Variation in Fracture Risk Estimation Among East Asian Women

Fracture prediction tools for East Asian individuals vary by country. In the United States, the US-Asian Fracture Risk Assessment Tool provides hip fracture probabilities that correspond to observed estimates.

How Do Primary Community Hospitals Enact Early Response to COVID-19? The Experience From Chengdu, China

Our hospital is a primary hospital in Chengdu, China. Since February 5, our hospital has been listed as the primary designated medical unit for treating new patients with coronavirus disease 2019 (COVID-19) in Jinniu District. In this letter, we share our COVID-19 experience with readers.

Implementation and Cost Validation of a Real-time Benefit Tool

This study evaluates impact of a real-time benefit tool on medication access and physician and pharmacy workflows at a large academic medical center.

Workforce Innovation Reduces Medicaid Costs in Chronic Care

This study of community health workers as clinical extenders demonstrates significant cost savings in managing chronic conditions among Medicaid beneficiaries.

Predicting Hospital Readmission in Medicaid Patients With Diabetes Using Administrative and Claims Data

A statistical model based entirely on claims data can accurately predict 30-day hospital readmission in Medicaid patients with diabetes.

Temporal Shift in Prevalence of Heart Failure Diagnoses and Comorbidities Within 2 US Integrated Health Systems

The analysis highlighted a shift in heart failure diagnoses, with hypertensive heart disease with and without chronic kidney disease as prevalent diagnoses, underlining coding variability and implications for research.

Relationships Between Patient Portal Activation and Patient Satisfaction Scores Among CG-CAHPS and HCAHPS Respondents

Patients with activated patient portal accounts report higher patient satisfaction in respective dimensions of the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) and Hospital CAHPS (HCAHPS) surveys compared with patients without portal accounts.

Care Transitions for Young Adults With Special Health Care Needs

A Medicaid managed care plan developed a pilot program to assist special needs youth with transition to adult care. Case studies and discussion present findings.

Provider Perceptions of Pharmacists in Primary Care–Based Accountable Care Organizations

In this article, the authors describe their experiences addressing provider perceptions and methods to overcome several challenges to clinical pharmacist integration in primary care–based accountable care organizations.

Implementing Team-Based Telemedicine Workflows in Safety-Net Primary Care

Telemedicine in safety-net primary care faces particular challenges. Consistent, team-based workflows can support video visit implementation and health care maintenance in telemedicine visits.

Managed Care Considerations for the Treatment of Chronic Cough

OneOncology’s Platform Approach to Deliver CAR T Therapies in Community Practices

OneOncology is using a community-based platform approach to catalyze broader access to care for patients with cancer while also advancing scientific discovery.

Real-World Users of Triple Therapy for Asthma in the US

This retrospective cohort study evaluated baseline demographics, clinical characteristics, and treatment patterns of US patients with asthma who newly initiated single- or multiple-inhaler triple therapy.

Teamwork Enhances Patient Experience: Linking TEAM and Net Promoter Scores

In 1386 providers, better teamwork related to higher patient Net Promoter Score (NPS), and the relationship between provider experience and NPS was mediated by teamwork.

Effects of Adjunctive Cariprazine Formulary Restrictions in Major Depressive Disorder

Patients who experienced a formulary-related rejection of cariprazine for adjunctive treatment of major depressive disorder had significantly higher hospitalization rates than those with approved claims.

Mental Health Service Utilization Review Patterns in a Medicaid Managed Care Program

Medicaid managed care utilization review data for mental health services were analyzed for the calendar years 2017 and 2018. These data indicate low rates of utilization review denials for both inpatient and outpatient mental health services.

Implementing Clinical Informatics Tools for Primary Care–Based Diabetic Retinopathy Screening

The authors describe a primary care–based diabetic retinopathy screening program incorporating telemedicine, strong health information technology engagement, and development of clinical informatics tools.

Improving Care Coordination and Reducing ED Utilization Through Patient Navigation

A navigation program demonstrated decreased odds of repeat emergency department (ED) visits in patients with low baseline ED utilization and increased odds of follow-up primary care appointments.

Understanding Insurance Coverage Policies for Incretin Mimetics for Weight Management

The high cost of incretin mimetics for weight management limits insurance coverage and potentiates variation in utilization management strategies to control near-term spending.

Pharmacist-Led Review of Empagliflozin and Ertugliflozin Following Formulary Update

Management of empagliflozin and ertugliflozin may be suboptimal following an insurance carrier’s formulary updates. Pharmacists may improve the management.

Managing Total Knee Replacement Under Value-Based Payments

This article describes the approach that a large primary care group at risk for value-based payments chose to deploy in managing clinical and financial outcomes of knee osteoarthritis jointly with orthopedic surgeons.

Improving Glycemic Control in Diabetes Through Virtual Interdisciplinary Rounds

Patients with diabetes whose providers received advice from remote, virtual interdisciplinary rounds had a greater 1-year reduction in hemoglobin A1c than comparable patients.

Pharmacogenomics for Improved Outcomes and Decreased Costs in Health Care

Economic Burden of Osteoporotic Fractures: The Tip of the Iceberg?

The economic burden of osteoporotic fractures may be much higher than estimated: just the tip of the iceberg. In this letter, we suggest that the cost of these fractures might be underestimated by considering only direct medical cost.